Physician assessment of disease activity in JIA subtypes. Analysis of data extracted from electronic medical recordsReport as inadecuate




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Pediatric Rheumatology

, 9:9

First Online: 14 April 2011Received: 03 November 2010Accepted: 14 April 2011

Abstract

ObjectiveAlthough electronic medical records EMRs have facilitated care for children with juvenile idiopathic arthritis JIA, analyses of treatment outcomes have required paper based or manually re-entered data. We have started EMR discrete data entry for JIA patient visits, including joint examination and global assessment, by physician and patient. In this preliminary study, we extracted data from the EMR to Xenobase™ TransMed Systems, Inc., Cupertino, CA, an application permitting cohort analyses of the relationship between global assessment to joint examination and subtype.

MethodsDuring clinic visits, data were entered into discrete fields in ambulatory visit forms in the EMR EpicCare™, Epic Systems, Verona, WI. Data were extracted using Clarity Reports, then de-identified and uploaded for analyses to Xenobase™. Parameters included joint examination, ILAR diagnostic classification, physician global assessment, patient global assessment, and patient pain score. Data for a single visit for each of 160 patients over a 2 month period, beginning March, 2010, were analyzed.

ResultsIn systemic JIA patients, strong correlations for physician global assessment were found with pain score, joint count and patient assessment. In contrast, physician assessment for patients with persistent oligoarticular and rheumatoid factor negative patients showed strong correlation with joint counts, but only moderate correlation with pain scores and patient global assessment. Conversely, for enthesitis patients, physician assessment correlated strongly with pain scores, and moderately with joint count and patient global assessment. Rheumatoid factor positive patients, the smallest group studied, showed moderate correlation for all three measures. Patient global assessment for systemic patients showed strong correlations with pain scores and joint count, similar to data for physician assessment. For polyarticular and enthesitis patients, correlation of patient global assessment with pain scores was strong. Moderate correlations were found between patient global assessment and joint count in oligoarticular and polyarticular patients.

ConclusionData extraction from the EMR is feasible and useful to evaluate JIA patients for indicators of treatment responsiveness. In this pilot study, we found correlates for physician global assessment of arthritis differed, according to disease subtype. Further data extraction and analyses will determine if these findings can be confirmed, and will assess other outcome measures, compare longitudinal responses to treatment, and export extracted data to multi-center databases.

Electronic supplementary materialThe online version of this article doi:10.1186-1546-0096-9-9 contains supplementary material, which is available to authorized users.

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Author: Michael L Miller - Jason Ruprecht - Deli Wang - Ying Zhou - George Lales - Sean McKenna - Marisa Klein-Gitelman

Source: https://link.springer.com/



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